by Noni Carter, 2018-19 IRWGS Graduate Fellow
At an IRWGS BODILY lecture in October, Australian scholar of science and technology studies, feminist theory, and literary studies J.R. Latham presented on the topic: Neither here nor there: testosterone’s absence and the politics of transgender medicine.
Latham’s research explores the types of issues transgender people face when seeking treatment from traditional medicine to assist in hormonal transitions. In his talk, Latham opened with a brief discussion on the ways in which medical access in general differs between “transwomen, transmen taking testosterone and those people designated female at birth who do not identify as men and/or do not take testosterone” (Latham abstract). The bulk of his presentation focused on the ways in which transmen (and transgender people/bodies more broadly) are not adequately conceived of, written about, and approached in healthcare. As doctors and medical specialists continue to have a profound impact on the transgender community, Latham argues that the medical industry requires a profound makeover, a wholesale revamping to account for the breadth of the trans experience.
Latham’s talk drew from the premise that the medical industry currently characterizes the transgender experience as a pathological condition; a disease in need of a cure. In this way, “transgender” is defined as a disorder that then can be straightforwardly identified, proven, diagnosed. This myth, Latham argues, leads to arbitrary and unethical treatment within the medical industry that then produces several problematic consequences.
For one, this understanding of transgender bodies in medicine reiterates cultural norms in that its primary and perhaps singular function is to create and secure a cis-gendered future. For example, other imagined gender categories that reflect alternative lived trans experiences do not appear in the 2013 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, the handbook used by health care professionals as the authoritative guide to the diagnosis of mental disorders), and therefore fail to have purchase in the ways the medical profession then administers treatment.Hence Latham’s argument that testosterone treatment for transmen currently lead to the singular experience of becoming non-transgendered without any room for other possibilities.
As a consequence, this transgender-as-disorder paradigm necessitates the existence of a certain gender dysphoria (the mental distress of one’s gender) that is, like gender itself, considered fixed and predetermined and in line with the DSM-5. Transgender medicine is practiced and provided only subsequent to rigorous psychiatric evaluation and intense medical surveillance that specialists use to confirm (or deny) the validity in a trans individual’s claim that he/she/they is really of the singular opposite gender. Transmen, for instance, before being allowed access to testosterone treatment, are required to articulate both a nightmarish past, a dreadful experience of puberty, and a desired imagined (non-trans) future. Yet what if trans is not just a distressing movement into or avoidance of puberty? Latham asks. What if there are non-chemical ways of experiencing trans-ness that sidestep this required experience of past “suffering?” The current paradigm does not allow space for these ideas.
As becomes clear, this practice fails to encompass the broad and diverse range of experiences that fall under the umbrella of transgender. It ignores and absents the variegated ways transgender people understand themselves, excluding those whose experiences do not fit the mold, erasing non-binary gender orientations. This in turn undercuts the possibility for honesty from transgender patients and oftentimes sets up exchanges of distrust. Reality, Latham argues, becomes sedimented out of the process of making the world more intelligible for these transgender patients through certain medical processes. Trans people do not get to decide what their experiences will look and feel like; the breadth of autobiographical accounts is never captured through this paradigm. Latham suggests, then, that “psychiatric referral should be made on an individual case-by-case basis, as it is with other aesthetic surgeries” (p. 648, 2013). He calls for the retraining of doctors and specialists with this understanding in mind.
This presentation led to lively discussion. Questions raised addressed: the future implications of the use of certain hormone treatments on patients that have not been sufficiently researched; the point at which informed consent can be escaped; how this reading of the medical industry informs the experience of trans and non-conforming children who are assumed to have a limited amount of self-knowledge. Also to note were questions regarding the political stakes of this debate, what state responsibilities towards the trans community include. For instance, how and when should state regimes fund or not fund these treatments? What incentives would encourage taxpayers to reconceptualize what they consider worthwhile? One individual brought up the extreme differences in the level of privilege to speak out, challenge, and critique these practices in the U.S. as opposed to other countries.
IRWGS is very grateful to Latham for his lecture.
References from Latham and audience:
- J.R. Latham, “(Re) making sex: A praxiography of the gender clinic” (2017)
- J.R. Latham, “Making and Treating Trans Problems: The Ontological Politics of Clinical Practices” (2017)
- Susan Stryker, Transgender history (2008)
- Norman Spack, et al., “Pediatrics: Transgender medicine – long-term outcomes from ‘The Dutch Model’” (2015)
- Sandy Stone, Empire Strikes Back: A Posttransexual Manifesto (1992)
- Nick Krieger, Nina Here nor There: My Journey Beyond Gender (2011)